1. Field of the Invention
This invention generally relates to a method and apparatus for resecting a proximal human tibia to allow it to properly accept a proximal tibial prosthesis in the context of a total knee replacement operation.
2. Related Art
In the past, efforts have been made to develop methods and apparatus to resect the proximal human tibia in the context of knee replacement surgery. Many of these previous efforts, as shown in the previous relevant patents, align the tibia resection off of the intermedullary canal of the tibia, while others base alignment off of exterior alignment rods. These previous efforts also include alignment adjustment mechanisms, though these mechanisms tend to be complicated and generally inaccurate. None of the methods or apparatus that have been developed can consistently and accurately locate and properly align the tibia resection, while minimizing the cutting skill necessary to properly and safely resect the tibia, as well as smoothly cutting the tibia. Nor do any of the previous efforts disclose a simple but effective method and apparatus for efficiently resecting the proximal tibia. These past efforts include:
Stillwell, U.S. Pat. No. 4,457,307, which discloses a movable saw and saw carriage which may be mounted to the femur for resecting the femur. The saw and saw carriage are adjustable through a plurality of positions to make desired cuts in the femur. Additionally, the device may be used to cut the proximal tibia. First, the knee is extended, the collateral ligaments are tensioned and balanced, and the proximal tibia cortex is scored. Then, the knee is flexed, the saw and saw carriage readjusted, and the tibia cortex cut is completed.
Androphy, U.S. Pat. No. 4,487,203, discloses a knee resection system comprising a guide member, femur and tibia guide rods, a tibia adaptor, a tibia bar, and a femur bar. After the distal femoral condyles are resected, the guide member is attached to the tibia guide rod extending into the tibia. The tibia guide rod has a second guide at a right angle for receiving the guide member. When properly aligned, the guide member is fixed to the anterior side of the proximal tibia with pins. The tibia is then resected with an oscillating saw inserted through slots in the guide member.
Rohr, Jr., U.S. Pat. No. 4,566,488, discloses a ligament tensor device having a first member to engage the tibia and a second member to engage the intercondylar notch of the femur. This device includes means for moving the first member with respect to the second member for applying a selected tension to the ligaments of the knee joint. The device includes a tibia cutting guide which supports a tibia cutting guide head which is positioned and angled to guide the cutting of the tibial plateau. The cutting guide head includes a transverse cutting guide slot. An ankle guide bracket is attached to the lower end of the tibia cutting guide and attaches to the tibia at the ankle for supporting and aligning the tibia cutting guide structure.
Kenna, U.S. Pat. Nos. 4,653,488 and 4,787,383, disclose a tibial cutting jig for cutting a tibia after the femur has been resected. The tibia is aligned off of the resected femur through longitudinal traction and manipulation to bring the ankle under the femur to produce a tibial angle of 2.5 degrees resulting in an overall valgus alignment. The alignment is verified by sight. The knee joint is then immobilized, the transverse tibial cutting jig is pinned to the tibia, the knee is moved to flexion, and the tibia is cut by resting the saw blade on the top surface of the cutting jig.
Russell, et al., U.S. Pat. No. 4,722,330, discloses a distal femoral surface guide for mounting on an intermedullary alignment guide for use in shaping the distal femoral surface. A conventional shaping means such as an oscillating saw or hand saw is introduced into slots in the surface guide to resect the femur. The device also includes stabilizing members that extend along the sides of the femur to stabilize the device.
Fargie, et al., U.S. Pat. No. 4,736,737 discloses a tibial cutting jig having a base that interconnects with an intermedullary alignment rod installed along the axis of the tibia. The base includes outriggers carrying measurement keys for spacing the base a preselected distance above the tibia. A saw guide having slots is attached to the base and is positioned to allow for the cutting of the tibia, by means of an oscillating saw, at a selected position.
Whiteside, et al., U.S. Pat. No. 5,002,545, discloses a shaping device for shaping the tibial plateau comprising an alignment rod located anterior to the anterior cruciate ligament and along the anterior cortex of the intermedullary canal of the tibia. The shaping guide is interconnected with the rod and is adjustable with respect to the rod to control the amount of resection of the tibial plateau by raising or lowering the cutting guide surfaces. The device includes a pin which is inserted into a hole on the alignment guide for setting rotation alignment by aligning the pin with the intercondylar notch of the femur.
Poggie, et al., U.S. Pat. No. 5,250,050 discloses an apparatus for use in preparing the bone surfaces for a total knee prothesis, comprising cutting guides, templates, alignment guides, a distractor and clamping instruments. The instrument for alignment of the cutting surface for resecting the tibia includes an ankle clamp, an adjustable alignment rod, and a cutting platform. After the cutting platform is properly aligned on the tibia, it is pinned thereto and the tibia may be resected using an oscillating saw. Also disclosed is a patella resection guide comprising a scissor-type clamp having distal gripping arms, each of which define a cutting surface, and gripping teeth.
Caspari, et al., U.S. Pat. Nos. 5,263,498, 5,228,459, and 5,304,181 disclose a method and apparatus for orthoscopically preparing bone surfaces for a knee replacement. A tibial jig is attached to the tibia at just above the ankle at a lower end and to just below the tibial tubercle at an upper end. One portal is formed in the knee for insertion of an orthoscope for viewing the knee, and another portal is formed for introducing resecting instruments. A cutting platform is aligned and secured in position and a cutting module is attached. Initially, a plunge cut across the tibial eminence is produced. This procedure is repeated until the surface of the tibial plateau is covered with trails having ridges therebetween. Thereafter, the device is passed back and forth over the tibial plateau to remove the ridges.
Morgan, U.S. Pat. No. 5,269,786, discloses a PCL oriented placement tibial guide method for guiding the tibial tunnel placement both inside and outside the knee in endoscopic ACL reconstruction.
Mikhail, U.S. Pat. No. 5,284,842, discloses a universal patellar clamp having an articular surface clamping member with a central aperture defining a centerline axis. An anterior clamping member is positioned along the centerline axis and is movable with respect to the articular clamping member to effect clamping of the patella for accepting a reamer for reaming a cavity in the patella of sufficient size to receive a patellar implant.
Johnson et al., U.S. Pat. No. 5,306,276, discloses a tibial resector guide including a tibial alignment jig having an ankle adjustment mechanism, a telescoping rod and a tibial resector guide which includes a head having a slot for receiving a bone saw. The head includes angled side walls along the slot which permit the guide to have a narrow anterior aperture, yet allow the saw blade to completely pass through the tibia.
Peterson, U.S. Pat. No. 5,342,368, discloses an intermedullary tibial resector guide which is affixed to the tibia by means of an intermedullary rod. An elongated bar extends from the intermedullary rod and carries a sleeve that supports a saw guide having a slot for receiving an oscillating saw.
Whitlock, et al., U.S. Pat. No. 5,147,365, discloses a patella osteotomy guide comprising a plier-like appliance with curved jaws for grasping a patella. A row of teeth face inwardly from the jaws and a rotating calibrated stylus measures the position of the patella with respect to an integral saw capture slot in each of the jaws. The jaws are curved with concave inner sides generally corresponding to the shape of a patella. With the guide attached to a patella, a sagittal saw can be passed through the saw capture slots to cut away a portion of the patella.
None of these previous efforts are as simple and easy to use as the present invention. Additionally, none of these previous efforts disclose all of the benefits and advantages of the present invention, nor do they teach or suggest all of the elements of the present invention.